After Two Years on Paleo Diet My Cholesterol Numbers Look Very Bad

Before I embarked on the Paleo journey, I had an extensive cardio exam done and made note of all of my blood markers. After two years on a hardcore Paleo diet I re-tested for cholesterol and the results are frankly pretty bad.

First, I should define my diet. I went from drinking a lot of carbonated sugar drinks, and eating processed foods that use lots of high fructose corn syrup to eating whole foods. All grains (wheat, oats, corn, rice, etc) are gone entirely from my diet. My carbohydrates consist of one cup of fruit in morning and then whole vegetables with the fiber intact. I eat a lot of meat and fish. I am skinny and was losing too much weight on this diet, so I started to supplement with lots of saturated fat. I cover my fruit in morning with coconut milk or coconut cream (Aryo-D has the best looking product which they claim is "pure" but I have my doubts). I also started putting organic whipping cream into my coffee and tea. That stopped my weight loss.

So, after two years of this diet, I have learned how to eat Paleo, and I feel good saying I don't have any major sources of fructose or glucose slipping into this diet. I sweeten foods with Stevia and a sugar alcohol named Erythritol. The latter absorbs through the intestine and passes out through urine and does NOT metabolize to calories! I find the combination of these two tastes very much like sugar but is zero calorie. I doubt these could be a source for the cholesterol test result.

Now, my blood test results are pretty ugly.

Mystery Number One. Two years ago I was an advertisement for the processed foods and sugar industries and I had a fasting glucose of 92. That's a little high and I thought I could do much better than that. Now, two years into Paleo I test at fasting glucose of 115. That is psychologically a major setback for me. How can I be getting a much worse fasting glucose number when I am not eating foods that would spike my insulin? I have no theory for how this is even possible. What do I look at to get this number down? I want my fasting glucose below 80 honestly.

Mystery Number Two. My blood numbers for lipids two years ago were definitely not great, but now they are REALLY bad. Two years ago:

Total Cholesterol 251
Triglycerides 60 // Triglycerides down which is good
HDL 53 // HDL up but not enough
LDL 186 // This is nightmare....VERY bad news
Cholesterol/HDL 4.7 // Improvement but barely

Total particle count LDL-P 2214 // this is also a nightmare....

LDL-P is the total count of LDL particles, and some people think this number alone is the single best indicator of heart disease risk. A number above 2000 puts me in the highest risk category. Unfortunately, this test is not easy to order and I didn't know about it when I was doing my baseline two years ago. So I don't have a comparison number. But a result above 2000 tells me I have an immediate and serious problem and I need to do something to get that number way down.

So, to be honest, I am really discouraged here. I can try to cut out the fruit in morning, but one cup should correspond to under 20 grams of fructose, and I doubt that explains this result. I have been drinking the coconut milk and organic whipping cream maybe a little too often. My guess is I must be getting 40% of my calories from saturated fat. Maybe that is just too much saturated fat.

Where do I go from here? What do I test? What do I adjust?

Does anyone know a consultant with available time whose skill level is on par with someone like Chris Kresser? I have tried for FOUR YEARS to see Chris but I think it is hopeless. His company had me on a waiting list and then lost me from that list. Then they put me on a waiting list and when I didn't see the one and only email they sent notifying me I could make an appointment they dropped me again. Now they say they can't add me to the list because it is four years long. Chris never replies to emails, voice mails, etc. Something just broken there I think....

My doctor wants to put me on statins, but they will not send me to that hell without a fight.

Just because your LDL is up may not mean anything bad. Your last blood test was two years ago which is hardly a trend. Your LDL levels are the total amount of cholesterol in your LDL particles. The size of the particles is what matters. Large is good and small/dense is bad. I would get retested and take it from there. Have you had your mineral levels checked? Personally, I wouldn't be worried.

Maybe it's just the other way round...trying to eat "healthy" from one point of view, doensn't obviously fit with your body?!
That might not sound PB but could be that you should go back to a more "balanced" diet regarding the macros...
Your body seems to be confused. I'd try to eat whatever I want, whatever pleases and gives me a good feeling. Think, there is not the one and only way of eating for everyone. Pb might just be wrong for you?

So apart from being skinny (too skinny?) how else are you feeling health-wise? Sleep, energy levels, mood, likeliness of falling ill, etc etc.

Why did you change your diet in the first place? Has it made a difference to anything other than your blood tests? After two years on primal you should know if you are feeling well or not.

I think I have always had a failure to thrive. I had a terrible wheat sensitivity (might have been celiac because it was extreme) that used to make me extremely ill. After I got off wheat I stopped being deathly ill, but failure to thrive means in general I suffer from a "brain fog" and lack of energy. If I go without food and literally just fast/starve, that clears quickly and I get a lot of mental clarity and energy. I wonder if my gut is still reacting to some other food.

I went on Paleo to try to improve my energy levels, improve muscle tone, and hopefully tackle cardio issues. It certainly improved muscle tone a lot. I can't say it changed my energy levels substantially. The cardio is so far a disaster.

Just because your LDL is up may not mean anything bad. Your last blood test was two years ago which is hardly a trend. Your LDL levels are the total amount of cholesterol in your LDL particles. The size of the particles is what matters. Large is good and small/dense is bad. I would get retested and take it from there. Have you had your mineral levels checked? Personally, I wouldn't be worried.

That test from two years ago was repeated with nearly identical numbers many times before that. It really was a multi-decade baseline. The numbers from the recent test are unlike numbers I have ever had in many many many years of getting cholesterol tested. They are remarkably different and remarkably higher.

In terms of particle sizes:

1) I had a sophisticated test done that breaks down the sizes, and I have plenty of medium-small particles too. I'm not lucky enough to just have large particles. I didn't break it down in my original post because there are about 10 different size categories.

2) To a large extent you can bypass the need to examine the particle sizes just by looking at the total LDL particle count. You can't have a large LDL-P if you only have large particles. Generally an LDL-P that is over 2000 means you have a very large number of smaller and medium size particles.

Maybe it's just the other way round...trying to eat "healthy" from one point of view, doensn't obviously fit with your body?!
That might not sound PB but could be that you should go back to a more "balanced" diet regarding the macros...
Your body seems to be confused. I'd try to eat whatever I want, whatever pleases and gives me a good feeling. Think, there is not the one and only way of eating for everyone. Pb might just be wrong for you?

My personality gravitates to a scientific approach. I want to understand the reasons for things.

Eating what "feels good" would at best get me back to the baseline, and the baseline wasn't great.

forget about my remark then! too much fat, too much meat, too much thinking about food?!

If we are not going to think about food on a Paleo discussion forum dedicated to nutrition, where are we going to think about it?

And I am not thinking about food too much. I'm trying to regain control on my cholesterol numbers, which apparently got worse as a result of the kind of food I am eating.

Heart disease is very real. My dad died of heart disease (fortunately at an old age). I think it is not a responsible message to ignore the warning signs of heart disease and just be happy. Each person can live their life as they choose, but for me this blood test is a warning shot across my bow and I want to do something to correct course. I am responsible for my own result, and I am doing something to affirm that.